Date of Award

2017

Document Type

Dissertation

Degree Name

Doctor of Health Administration

College

College of Health Professions

First Advisor

Kit N. Simpson

Second Advisor

Annie N. Simpson

Third Advisor

Cheava Jacks

Fourth Advisor

James S Zoller

Abstract

Across this nation, rural hospitals are closing at an alarming rate. The critical access hospital designation was created in 1997 (Balanced Budget Act, 1997) to assist the rural facilities in remaining solvent with increased cash-flows on a cost reimbursement basis. The Swing Bed program was also launched in 1980 (Silverman, 1990) to assist the rural facilities by increasing their average daily census. This skilled nursing program was created for step down treatment of patients who were not ready to be discharged “home”. These Federal programs, such as the Omnibus Reconciliation Act of 1980 (Public Law 96-499) were developed to assist in keeping these rural healthcare facilities in operation. However, they have not, and could not have solved all of the problems associated with these organizations. The lack of knowledgeable and effective leadership at the Chief Executive Officer level is a root cause for many of the critical access hospital closures. Therefore, this administrative case study was developed to describe a promising new business model to ameliorate the problems affecting the viability of critical access hospitals. The model has the following components: 1) Identifying the facilities that can be “saved” and the critical attributes associated with the identification of survival risk for these organizations; and 2) reengineering of these hospitals to function as Patient-Centered Medical Homes. These two steps are at the core of this administrative case study. The major assumption underlying the approach is that the development of these hospitals into Medical Homes will prove to be an effective solution to returning these facilities to financially and operationally healthy organizations. An essential aspect of the reengineering of a hospital is the metrics that are implemented and used to summarize the process. We describe the types of empirical data collected, quantitative analysis, and the planned tools needed for qualitative analysis. Only the initial assessments and the plans for future assessments are described here because the process is expected to continuously evolve over a three to five year time period. Thus, only the future will show if this approach is truly effective.

Rights

All rights reserved. Copyright is held by the author.

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